The recent deaths of more than 70 children in less than a week’s span at the BRD Medical College Hospital have focused attention on the deep-seated rot in the hospital, and in Gorakhpur district in general. But far from being an under-performer in terms of health and development outcomes, Gorakhpur performs as good as, if not better than, the state average, on most indicators, a Mint analysis shows.

The data suggests that Gorakhpur is far from a backwater compared to Uttar Pradesh’s (UP’s) standards. And the fact that large-scale deaths could take place there shows that such tragedies can recur, possibly in a even more devastating form, if systemic challenges in healthcare remain unaddressed.

As the chart below shows, the proportion of households with an improved source of drinking water is higher in Gorakhpur than in the rest of the state. The proportion of those having toilets is nearly the same, shows data from the latest round of the National Family Health Survey (NFHS) conducted in 2015-16. The proportion of underweight children is lower in Gorakhpur compared to rest of UP and the proportion of children with full immunization (BCG, measles and 3 doses each of polio and DBT) is higher compared to the state average.

Compared to the region it lies in (Purvanchal), as well as the entire state, Gorakhpur is an outperformer when it comes to most development indicators, as an earlier Plain Facts column had shown. On several indicators, Gorakhpur betters even the all-India averages.

Thus, Gorakhpur tragedy should be a wake-up call for the rest of UP, where things are even more likely to go wrong. As the chart below shows, UP’s overall record in health has been quite dismal over the past decade.

Whether it be infant mortality or under-weight children, the rate of progress in UP has lagged the rest of the country. One key reason for this is lack of resources. Although allocation to health has risen over the past few years, and UP spends more on health as a share of its state budget than many other states, it still translates to lower per capita health spending because of its large population. According to data from the Centre for Monitoring Indian Economy (CMIE), at 0.8% of its state gross domestic product (GSDP), UP spent more on health than states such as Gujarat, Punjab, Karnataka, and West Bengal in fiscal 2015, the latest year for which comparable data for all states are available. But this translates to a very low per capita spend on health, as the chart below illustrates.

The lack of resources commensurate to its size has meant that UP is chronically short of staff and infrastructure. According to the 2016 Rural Health Statistics released by the Ministry of Health and Family Welfare, half of sanctioned positions for doctors in rural primary health centres were vacant in Uttar Pradesh. The increase in the number of sub centres, primary health centres and community health centres in UP was less than 1% between 2005 and 2016.

The lack of resources has manifested itself in poor outcomes. Between 2007 and 2013, the share of deaths due to communicable, maternal, perinatal and nutritional conditions was much higher in UP than in the rest of the country, according to data from the Sample Registration System, which suggests that the state of basic health infrastructure is far weaker than the rest of the country.

To be sure, the poor outcomes are not merely a reflection of inadequate resources. Even the existing resources have been mismanaged. A Comptroller and Auditor General of India report on the performance of Reproductive and Child Health sector in the fiscal year ended March 2016 showed that vaccines to various districts in UP were in short supply while 52% of the funds with the State Health Societies remained unspent in 2015-16. High-level corruption has also stymied progress in health in the past. In June this year, the CBI filed a supplementary charge-sheet against the former head of the National Rural Health Mission (NRHM) and a former minister on charges of corruption in implementing the NRHM scheme.

What is true of UP is of course true of the country to some extent. India has been a laggard in health spending and health outcomes for quite some time now. But India’s healthcare crisis seems to be most acute in its most populous state.